Provider Demographics
NPI:1568419554
Name:FOWLER, RICHARD SIBLEY (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SIBLEY
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15294
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28813-0294
Mailing Address - Country:US
Mailing Address - Phone:828-665-0442
Mailing Address - Fax:828-665-0412
Practice Address - Street 1:828 FLEMING ST
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3540
Practice Address - Country:US
Practice Address - Phone:828-698-3489
Practice Address - Fax:828-698-3490
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0783AOtherBC/BS
NC0783AOtherBC/BS